The Francis report suggests changes to pre-registration training to improve skills and to ensure students have the requisite attributes
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Much of the care at the Mid-Staffordshire Foundation Trust was below an acceptable standard due to a lack of staff, but Robert Francis QC also attributes some of the failings to nursing staff not being skilled enough to provide the care required.
The evidence collected by the inquiry shows several examples of poor care putting patients at risk and delaying recovery; this was the result of some of the nurses not having the skills to cope (Francis, 2013).
To combat this, Mr Francis has suggested changes in nurse education to create a more compassionate workforce that is able to provide the care required.
Student nurse selection criteria
The report stresses a need to recruit onto nursing courses only those who possess “the appropriate values, attitudes and behaviours”. Mr Francis said that student nurses need to be intelligent, caring and possess an intrinsic desire to help others.
To ensure that nurses are motivated to maximise the welfare of others, Mr Francis suggests that one of the minimum requirements to study nursing should be three months’ experience of working in direct patient care, under the supervision of a qualified nurse. He argues that this will ensure only students who are committed to becoming good nurses and who possess the necessary qualities will be given the opportunity to train.
In addition, this recommendation would give potential student nurses an insight into what is involved before they start a nursing course. Mr Francis said that “even in a well-run organisation, the stark differences between nursing as they imagined it to be and the reality will challenge their ability to maintain their motivation”.
But the government’s response published last week suggests pilot schemes should be rolled out to make students work for a year as a healthcare assistant before receiving funding for a nursing degree.
He also suggested that, before starting their training, potential student nurses undertake an aptitude test designed to ensure they are willing to undertake hands-on care and are capable of doing this, and are not just interested in the more technical aspects of nursing. The thinking behind this test is not to assess knowledge but to check that prospective students have the caring and compassionate qualities to be a good nurse.
Changes to nurse training
Reassuringly, the report acknowledges that the existing education system does not make nurses incapable of providing personal care.
However, the evidence collected by the inquiry included examples of poor basic care and the conclusion was drawn that the current model of training does not focus enough on the impact of culture on caring.
The report highlights the need for student nurses to be provided with more training on practical elements of nursing, such as lifting and personal care, and for this to be governed by national standards. It stressed that these are skilled tasks that require an appropriate level of training to ensure nurses are competent in them.
Currently, student nurses are expected to learn these skills while on placement. However, as students undertake different placements, the amount and type of practical training they receive vary considerably. Mr Francis recommends that all student nurses, regardless of where they train, are taught practical nursing skills to a consistently high standard.
The report recommends that students all take the same exams and achieve the same qualification at the end of the course. Exams should include practical elements of care in addition to testing knowledge. The aim of making all student nurses take the same exams is to reduce differences in the standard of education provided by different institutions, and to prevent anyone who is not capable of providing compassionate and safe care from working as a nurse.
Mr Francis has advised that there should be a greater focus on nurse training, education and professional development. The report recommends that more emphasis should to put on the practical requirements of delivering compassionate care, in addition to the theory.
The first step to achieving this is by recruiting student nurses who already possess compassionate qualities and the potential to be caring, practical nurses.
This, along with including more practical elements in nursing courses, is intended to produce workforce of skilled, caring nurses who can change the culture of the health service.
Fran Entwistle is assistant practice and web editor at Nursing Times.
Francis R (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. London: the Stationery Office.